---
title: "Community Health Plan of Washington ABA coverage: the intake guide."
url: "https://carelu.com/payers/community-health-plan-of-washington"
markdown_url: "https://carelu.com/payers/community-health-plan-of-washington.md"
state: WA (Washington)
payer: Community Health Plan of Washington
kind: Medicaid managed care plan (MCO)
parent_program: Washington Apple Health (HCA)
description: "How Community Health Plan of Washington covers ABA for Apple Health members: prior authorization on the 2026 behavioral list, the ABA Initial Request Form and COE documents, credentialing for LBAs vs. CBTs and LABAs, timely filing, and what intake should collect."
last_reviewed: October 2026
---

# Community Health Plan of Washington ABA coverage: the intake guide.

_Payer Guide · Community Health Plan of Washington · Last updated October 2026 · 10 primary sources_

> Apple Health MCO: ABA needs PA on its 2026 BH list; fax the ABA Initial Request Form with the COE evaluation; 12-month timely filing.

Community Health Plan of Washington (CHPW) is one of the five Apple Health managed care plans HCA lists. It runs ABA under the state’s chapter 182-531A WAC pathway: a Center of Excellence evaluation and prescription, an LBAT assessment and plan, then CHPW prior authorization. Its 2026 behavioral prior-authorization list names ABA, and its ABA Initial Request Form lists exactly which documents to send.

This plan administers the **Washington Apple Health (HCA)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Washington Apple Health (Medicaid) guide](https://carelu.com/payers/washington-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: CHPW customer service, (800) 440-1561, or CHPW’s Procedure Code Lookup Tool: check 97151 and 97152 for an initial assessment. [1][7]
- **Prior auth for treatment**: Yes. ABA is on CHPW’s 2026 "Prior Authorization Required" behavioral list; submit the ABA Therapy Initial Request Form by fax to 206-613-8873 (or the JIVA portal), and recertification requests at least 3 weeks before the current authorization expires [1][2][4]
- **Autism diagnosis required?**: Yes. The initial request requires an "Autism Center of Excellence evaluation with diagnosis of autism spectrum disorder" and the COE’s recommendation for ABA; the state rule allows ASD or another developmental/intellectual disability for which ABA is effective (WAC 182-531A-0400) [2][6]

## At a glance

- **Covers ABA?:** Yes, for Apple Health members, under WAC 182-531A
- **Prior auth:** Required (2026 BH PA list); ABA Therapy Initial Request Form, fax 206-613-8873, or JIVA portal
- **Initial request needs:** COE evaluation with ASD diagnosis, COE recommendation, ABA functional and skill assessment/FBA, treatment plan
- **Recertification:** At least 3 weeks before the current authorization expires
- **Credentialing:** LBAs credentialed (CAQH); CBTs and LABAs rostered, not individually credentialed
- **Claims:** Availity payer ID CHPWA; taxonomy 103K00000X in billing and servicing fields
- **Timely filing:** 12 months from date of service; corrected claims 24 months

## Prior authorization and the documents CHPW wants

CHPW’s 2026 Prior Authorization List and Utilization Guidelines for behavioral services (effective January 1, 2026) put "Applied Behavior Analysis (ABA) for Autism Spectrum Disorder" and "Treatment provided to members diagnosed with Autism Spectrum Disorder and other Developmental Disorders" under "PRIOR AUTHORIZATION REQUIRED." Requests go on the ABA Therapy Initial Request Form by fax to 206-613-8873; CHPW told providers at HCA’s February 2025 ABA session that its JIVA portal is "the preferred method." The form says the multidisciplinary plan is implemented "for a six-month period," and that providers in the authorization are limited to "State-approved ABA Center of Excellence teams and/or CHPW-credentialed ABA providers." [1][2][3][4]

Initial authorization requires the Center of Excellence evaluation with the ASD diagnosis, the COE’s recommendation for ABA, the ABA provider’s functional assessment, skill assessment or functional behavioral analysis, and the treatment plan. Recertification is "Submitted at least 3 weeks prior to expiration of current authorization" with a revised plan, measurable changes in the frequency, intensity and duration of targeted behaviors, the projected outcome, assessment instruments, developmental markers of readiness, evidence of coordination and of compliance with the plan; improvements must be confirmed with data, documented in charts or graphs, durable and generalized outside the treatment setting. [1][2][3][4]

## Network entry, credentialing and claims

CHPW requires a signed Apple Health core provider agreement and NPIs registered with HCA for every clinician. Licensed behavior analysts are credentialed (through CAQH or a Washington Practitioner Application to Provider.Credentialing@chpw.org); certified behavior technicians and licensed assistant behavior analysts are not individually credentialed but must be on the group’s roster, where they are loaded as "cred omitted." Re-credentialing is every three years. Claims go to Availity payer ID CHPWA (paper to CHPW Claims, PO Box 269002, Plano, TX 75026-9002) with taxonomy 103K00000X in both the billing and servicing fields. Timely filing: 12 months from the date of service as primary, 12 months from the primary payer’s remittance date as secondary, and 24 months for corrected claims; as secondary, CHPW "follows the primary payors denial/processing policies." Members can reach CHPW’s ABA line at 1-844-225-8624. [4][7]

CHPW’s provider manual could not be read this run (chpw.org returns a 403 to automated requests), so the state rules below are stated as Apple Health rules with "confirm with CHPW." [4][7]

## Intake gates

The questions that decide whether a family can start with Community Health Plan of Washington, and what they have to bring.

- **Who may diagnose**: A state-approved ABA Center of Excellence; the form limits providers in the authorization to "State-approved ABA Center of Excellence teams and/or CHPW-credentialed ABA providers." A Center of Excellence: an individual provider, not a facility. Licensed under Title 18 RCW and experienced in diagnosing and treating ASD, a developmental pediatrician, neurologist, pediatric neurologist, pediatric psychiatrist, psychiatrist or psychologist qualifies whether or not they are on HCA’s COE list. ARNPs (including psychiatric mental health nurse practitioners), physicians, physician assistants and naturopaths qualify only after HCA’s COE training and designation, on a signed COE Attestation form HCA 13-0009 (WAC 182-531A-0800). HCA may, at its discretion, accept a non-COE evaluation, for example a recent evaluation paid by the child’s primary insurance. A COE serving an MCO member must also be contracted with that MCO. [2][6]
- **Diagnostic tools required**: CHPW names no instrument. The state COE documentation rule applies: The COE documents "Results of formal diagnostic procedures performed by a provider, including name of measure, dates, and results, as available," or the clinical findings and observations used to confirm the diagnosis (WAC 182-531A-0500). The rule’s examples of ASD diagnostic tools are the ADI and the ADOS. If the COE has them, the evaluation must also include the ASD screening tool and date, a formal cognitive or developmental assessment with verbal, nonverbal and full-scale scores (examples: Mullen, Bayley, Wechsler) and a formal adaptive behavior assessment with domain scores (Vineland, ABAS), plus vision and hearing results. [2][6]
- **Referral required?**: Yes: the COE’s "recommendation for ABA therapy" is a required initial document. Yes: a COE prescription. "Any person may refer a client" to a COE for an evaluation, including the PCP, a school or early intervention professional, the family or the MCO, though many COEs require a PCP referral and an MCO may require prior authorization for the COE evaluation. If the COE concludes ABA is appropriate it writes "a prescription for ABA services" and sends the evaluation and prescription to the chosen ABA provider or the family (WAC 182-531A-0500). The COE evaluation and order go in with the first PA request. [2][6][7]
- **Other insurance (who pays first)**: CHPW is secondary to other coverage: a secondary claim is due within 12 months of the primary payer’s remittance date, and as secondary "CHPW follows the primary payors denial/processing policies." Medicaid is payer of last resort (42 CFR 433.139). [4][9]
- **Prior-auth decision time** _(plan-dependent)_: CHPW publishes no ABA decision timeframe in the documents read. Federal managed care rules apply: for rating periods starting on or after January 1, 2026, standard authorization decisions "may not exceed 7 calendar days after receiving the request for service" (42 CFR 438.210(d)). [8][2]
  - Ask the plan: CHPW utilization management via JIVA or (800) 440-1561.
- **Diagnosis recency** _(ask the plan)_: Not stated by CHPW. The state rule: the plan must correlate with the COE’s current evaluation, and requests are due within 60 days of the LBAT assessment. [2][6]
  - Ask the plan: CHPW utilization management: ask how old a COE evaluation may be for an initial request.

## Delivery and billing rules

Coverage decides whether Community Health Plan of Washington pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Bill as provider**: The rendering clinician’s NPI. CHPW requires taxonomy 103K00000X "in both the billing and the servicing taxonomy fields," every clinician’s NPI registered with HCA, and all ABA staff on the roster; HCA requires the LBA, LABA or CBT who performed the service in the servicing provider box for dates of service from July 1, 2025. [4][7]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in CHPW’s ABA documents read, and the state guide does not settle 97153/97155 overlap either. [2][7]
  - Ask the plan: CHPW customer service, (800) 440-1561, or your CHPW provider agreement.
- **Daily limits / MUEs** _(ask the plan)_: CHPW publishes no ABA unit limits in the documents read; units are set per six-month authorization. [2]
  - Ask the plan: CHPW utilization management via JIVA or (800) 440-1561: ask whether HCA’s fee-schedule limits (97151 28 units per assessment, 2 a year) apply.

## What intake should collect for Community Health Plan of Washington

- **Member ID:** Confirm CHPW Apple Health (not Cascade Select or Medicare) on the date of service; enrollment can change monthly.
- **COE evaluation + recommendation:** The ASD diagnosis and the COE’s written recommendation for ABA are required for the initial request.
- **Assessment package:** Functional assessment, skill assessment or FBA, and the treatment plan for the six-month period.
- **Other insurance:** CHPW is secondary to commercial coverage; it follows the primary payer’s processing decisions.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does Community Health Plan of Washington require prior authorization for ABA?

Yes. ABA is on CHPW’s 2026 behavioral prior-authorization list. Fax the ABA Therapy Initial Request Form to 206-613-8873 or use the JIVA portal, with the COE evaluation, the COE recommendation, the assessment and the treatment plan.

### Do CBTs and LABAs need to be credentialed with CHPW?

No. CHPW credentials licensed behavior analysts; CBTs and LABAs go on the group roster and are loaded as "cred omitted." All of them need an NPI registered with HCA.

### What is CHPW’s timely filing limit?

12 months from the date of service when CHPW is primary, 12 months from the primary payer’s remittance date when secondary, and 24 months for corrected claims.

## Primary sources

1. [Community Health Plan of Washington — 2026 Prior Authorization List and Utilization Guidelines, Behavioral Services (eff. January 1, 2026)](https://www.chpw.org/wp-content/uploads/content/provider-center/prior-authorization/2026/Prior-Authorization-List-and-Utilization-Guidelines-Behavioral-Services.pdf)
2. [Community Health Plan of Washington — ABA Therapy Initial Request Form (fax 206-613-8873)](https://www.chpw.org/wp-content/uploads/content/provider-center/prior-authorization/ABA-Therapy-Request-Form.pdf)
3. [Community Health Plan of Washington — Behavioral health prior authorization (forms page)](https://www.chpw.org/provider-center/prior-authorization/behavioral-prior-authorization/)
4. [HCA — ABA Provider Technical Assistance webinar slides, with DOH and all five Apple Health MCOs (February 27, 2025)](https://www.hca.wa.gov/assets/billers-and-providers/aba-provider-technical-assistance-february-27-2025.pdf)
5. [HCA — Apple Health managed care (plan list and phone numbers)](https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/apple-health-managed-care)
6. [Chapter 182-531A WAC — Applied behavior analysis (Apple Health ABA rules: COE evaluation, stages, provider requirements, PA)](https://app.leg.wa.gov/wac/default.aspx?cite=182-531A&full=true)
7. [HCA — Washington Apple Health Applied Behavior Analysis (ABA) Program Billing Guide (January 1, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/aba-services-bg-20260101.pdf)
8. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
9. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
10. [CHPW — Bulletin Board (provider alerts and newsletter archive)](https://www.chpw.org/bulletin-board/)
11. [HCA — Washington Apple Health Telemedicine Policy and Billing Guide (January 1, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/telemedicine-policy-and-billing-bg-20260101.pdf)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.